AB0361 BONN PULSA: PULMONARY SCREENING IN ARTHRITIS - PREVALENCE OF PULMONARY MANIFESTATIONS IN PATIENTS WITH NEWLY DIAGNOSED RHEUMATOID ARTHRITIS, PSORIATIC ARTHRITIS, AND PERIPHERAL SPONDYLOARTHRITIS
Authors: L. Winter, D. Skowasch, M. Weber, D. Kütting, C. Behning, P. Brossart, V. Schäfer
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Pulmonary impairment in rheumatic diseases is a common, but poorly understood and deficient screened and managed extraarticular manifestation, which causes a huge increase in morbidity and mortality[1]. As previous studies focused on rheumatoid arthritis (RA) and in some intent on psoriatic arthritis (PsA), data for patients with peripheral spondyloarthritis (pSpA) is lacking. <h3>Objectives</h3> To investigate the prevalence of clinical and subclinical pulmonary manifestations in newly diagnosed patients with RA, PsA, and pSpA and to compare different baseline examination results to develop a screening proposal for detecting patients at risk. <h3>Methods</h3> This clinical-prospective, longitudinal cohort study included a diagnostic workup consisting of a questionnaire for patient history, a physical examination, a body plethysmography with CO diffusion capacity (DLCO), a 6-minute walk test, laboratory parameters, and a chest x-ray (CXR) at the time of the initial diagnosis of arthritis disease, and at four additional time points in three-month intervals. This paper focuses on the baseline characteristics. <h3>Results</h3> 54 outpatients (26 RA, 24 PsA, 4 pSpA) and 26 age- and gender-matched controls were examined. Pulmonary impairment, in the sense of a morphologically abnormal CXR, was diagnosed in 19 arthritis patients (38.0%). 36.8% of these suffered from clinical symptoms, such as cough and/or dyspnea. However, 63.2% presented subclinical, asymptomatic pulmonary abnormalities (see Figure 1). The baseline results of several examinations are illustrated in Table 1. An elevation of rheumatoid factor (&gt; 14 IU/ml) showed an association with the manifestation of RA (p=0.002) as well as with the presence of pulmonary affection (p=0.008). In addition, the mean age of patients with pulmonary abnormalities (57.0 ± 12.8 yrs.) was different from that of patients without such abnormalities (43.9 ± 14.3 yrs.), with a p-value of 0.002. The association between the activity of arthritis disease, assessed by Disease Activity Score in 28 joints using CRP (DAS28CRP), and CXR findings proved to be significant (p=0.011). A DAS28CRP less than 3.2 (remission or low disease activity) indicated non-pathological findings in CXR. <h3>Conclusion</h3> The prevalence of pulmonary manifestations was more than one-third, of which more than two-thirds presented asymptomatic. The large proportion of asymptomatic subjects highlights the need for the implementation of a pulmonary screening at the initial diagnosis of arthritis disease. By alerting physicians, especially in the observed age cohort of 57 years with elevated RF levels, morbidity and mortality could be reduced. <h3>Reference</h3> [1] Esposito AJ, Chu SG, Madan R, <i>et al.</i> Thoracic Manifestations of Rheumatoid Arthritis. <i>Clinics in Chest Medicine</i> 2019;<b>40</b>:545–60. doi:10.1016/j.ccm.2019.05.003 <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.